Does your family live in one of 9 Sacramento areas where many children test high for lead?
California State Auditor Elaine Howle reported Tuesday that 1.4 million children covered by Medi-Cal have not received state-mandated testing for lead poisoning even though the metal can cause behavioral disorders, loss of hearing, impaired physical development and death.
In the report, the auditor revealed nine census tracts in the Sacramento region where a large number of children under the age of 6 have tested positive for lead poisoning but where children ages 1 and 2 covered by Medi-Cal have been woefully under-tested. They include one tract in the city of Sacramento as well as eight others in the Carmichael, Foothill Farms and Arden Arcade areas of Sacramento County.
The California Department of Health Care Services “has not met its responsibility to ensure that children in Medi-Cal receive required tests at the ages of one and two years to determine whether they have elevated lead levels,” Howle stated in the report.
She said there had been lax oversight of whether managed care plans are ensuring that children are being tested but that the agency was implementing a financial incentive program that would encourage providers to do the testing.
“However, we are concerned by how long it may take these programs to influence lead testing rates,” Howle’s audit stated. “While it begins enforcing the new performance standard and making incentive payments, DHCS could also take more immediate action that may increase the number of children receiving required tests. Specifically, DHCS could require health care plans to identify children who have not received lead tests and remind their health care providers of the need to provide the tests — a method other states have successfully used to increase testing rates.”
In 2017, roughly 10,000 children in California were found to have elevated levels of lead in their bodies, the report said.
Howle said her team examined data from the public health department and found that, in fiscal years 2013 to 2018, a small percentage of state census tracts were home to the majority of children who are found to have lead poisoning, but the California Department of Public Health is not doing enough proactive work to abate lead hazards prior to exposure.
Specifically, the report stated, public health leaders also failed to adhere to a statutory requirement to post on its website a list of census tracts in which children have tested positive for certain lead levels. Rather, the auditor said, the agency has focused on removing lead from the homes of children who already have lead poisoning.
Looking at state data from fiscal 2013-2017, the auditor’s staff identified 50 census tracts in California where the largest number of children with elevated lead levels reside. Nine of them were in Sacramento County. Howle’s team then checked to see how many children enrolled in Medi-Cal had gotten mandated testing in those areas at ages 1 and 2. About 30 percent had. Roughly 70 percent did not.
The children lived in these defined areas:
▪ Census tract 62.01 in Arden Arcade area, bordered by Auburn Boulevard, Howe Avenue, Fulton Avenue and El Camino Avenue.
▪ 55.05 in Arden Arcade area, south of 62.01, bordered by El Camino, Howe, Fulton and Arden Way.
▪ 56.05 in Arden Arcade area, bordered by Arden, Fulton, Watt Avenue and Hurley Way.
▪ 61.01 in Arden Arcade area, east of 62.01, bordered by Auburn Boulevard, Fulton, Watt and Marconi Avenue.
▪ 61.02 in Arden Arcade area, east of 62.01 and south of 61.01, bordered by Marconi, Fulton, Watt and El Camino.
▪ 60.02 in Arden Arcade area, east of 61.02, bordered by Robertson Avenue, Watt , Eastern Avenue and El Camino.
▪ 74.13 in Sacramento, bordered by Roseville Road, Auburn Boulevard, Longview Drive and Park Road.
▪ 74.23 in the North Highlands neighborhood, bordered by Roseville Road, Palm Avenue and Walerga Road.
▪ 77.01 in Carmichael, bordered by Walnut Avenue, North Avenue, El Camino and Fair Oaks Boulevard.
Other counties with multiple census tracts in the top 50 were Fresno at eight; Los Angeles at seven; Humboldt and Imperial at four each; San Bernardino at three; and Orange, San Diego, Madera and Riverside at two each.
The auditor called upon the Public Health Department to immediately complete and publicize an analysis of high-risk areas around the state.
Rather than taking on the effort to identify and treat children, state public health leaders have contracted with local lead prevention programs to do this work but have not effectively documented whether these agencies are reducing lead exposure, the auditor stated. The Department of Public Health also is using outdated information to allocate funding for these local agencies, leading to significant differences in the programs that can be offered.
Howle’s report called upon the Department of Public Health to update factors that health care provides use to determine whether children are at higher risk for lead poisoning. She also said the agency already should have sought legislation that would allow CDPH to clear a backlog of unprocessed test results and ensure that lead tests could be matched with existing cases of lead poisoning.
“To support CDPH’s efforts to efficiently contact families and monitor lead test results, the Legislature should amend state law to require laboratories to report contact information and unique identifiers with children’s lead test results,” Howle recommended in the audit.
Howle said leadership at the Department of Health Care Services with her team’s findings and was implementing certain recommendations but that she did not think the approaches to implementation would remedy the problems. At the Public Health Department, Howle, said, leaders agreed or partially agreed with the findings, but she also felt the approaches the agency took would not sufficiently remedy key concerns.
This story was originally published January 7, 2020 at 1:23 PM.
